List of Sickness Covered by SSS and How to Claim It?

The Social Security System (SSS) in the Philippines acts like a community savings group, where every working Filipino chips in a small amount each month. Think of it as a giant piggy bank that you can tap into when life gets tough—whether it’s due to sickness, retirement, or other challenges. For someone like Aling Nena, who runs a sari-sari store in Quezon City, or Kuya John, a Grab driver in Davao, SSS contributions are a small price to pay for the peace of mind that comes with knowing they’re covered during tough times.

List of Sickness Covered by SSS and How to Claim It

This guide focuses on the SSS Sickness Benefit, a cash allowance designed to support members who can’t work due to illness or injury. We’ll cover the list of sickness covered by SSS, how to claim the benefit, eligibility criteria, how the benefit is calculated, and how to ensure you’re contributing correctly to stay eligible. We’ll use relatable Filipino examples and analogies to make it easy to understand, especially for those new to SSS.

List of Sickness Covered by SSS in 2025

The SSS Sickness Benefit likely covers a variety of conditions that prevent you from working, provided you’re confined for at least four days. Here’s a breakdown of the SSS covered illnesses:

  • Chronic Illnesses: Conditions such as hypertension, arthritis, diabetes, and cancer are covered. If Aling Nena is diagnosed with diabetes and needs regular treatment that keeps her from her store, SSS can provide payments to help cover her medical costs and daily expenses.
  • Short-term Illnesses: Common ailments like colds, flu, or minor injuries qualify if they require at least four days of confinement at home or in a hospital. For example, if Kuya John sprains his ankle and can’t drive for a week, SSS can step in to help.
  • Maternity: Pregnant SSS members can access maternity benefits to cover prenatal care, delivery, and postpartum expenses, easing the financial burden of welcoming a new child.
  • Disability: If an illness or injury leads to a disability, SSS offers monthly financial support to help members adjust to their new circumstances.
  • Death: If a member passes away due to a covered illness or injury, their beneficiaries may receive death benefits to help with funeral costs and other expenses.

This coverage is like a protective umbrella during a storm. When life throws you a curveball—like a sudden illness or injury—SSS is there to shield you from the financial rain, ensuring you can focus on recovery without worrying about bills.

Eligibility for SSS Sickness Benefit in 2025

To qualify for the SSS Sickness Benefit in 2025, you must meet these criteria:

  • Inability to Work: You must be unable to work due to sickness or injury and be confined at home or in a hospital for at least four days.
  • Contribution Requirement: You need to have paid at least three months of SSS contributions within the 12 months immediately before the semester of your sickness or injury.
  • Exhausted Company Sick Leave: If employed, you must have used all your company-provided sick leave with pay for the year (this doesn’t apply to sea-based OFWs).
  • Timely Notification: Notify your employer (if employed) within five calendar days of home confinement, or SSS directly (if self-employed, voluntary, OFW, or separated) within the same period. For hospital confinement, notify SSS within one year from the date of discharge.

Failure to notify within these deadlines may lead to a reduced claim or denial. If the deadline falls on a weekend or holiday, you can submit the claim on the next working day.

How to Claim SSS Sickness Benefit in 2025

Claiming your SSS Sickness Benefit involves three main steps, designed to be straightforward but requiring attention to detail:

  1. Notify SSS:
    • Employees: Inform your employer within five calendar days from the start of home confinement. Your employer will notify SSS online.
    • Self-Employed/Voluntary Members/OFWs/Separated Members: Notify SSS directly within five calendar days via your My.SSS account.
    • Hospital Confinement: Notify SSS within one year from the date of discharge.
    • This step is like telling your neighbor you need to borrow their umbrella when it starts raining—you need to act quickly to get the help you need.
  2. Submit Documents:
    • Medical Certificate (Med 01688): Obtain this from your doctor, detailing your diagnosis, recommended rest period, doctor’s address, contact number, and license number.
    • Additional Documents for Longer Illnesses: For extended or severe conditions, you may need to provide lab results, X-rays, or hospital records.
    • Proof of Account (POA): Enroll your bank account or e-wallet in the Disbursement Account Enrollment Module (DAEM) on the My.SSS Portal. Upload proof of account, a government-issued ID, and a selfie holding both the ID and POA in JPEG or PDF format.
    • This is like showing your neighbor it’s really raining by presenting your doctor’s note, ensuring they trust you enough to lend the umbrella.
  3. Wait for Processing:
    • SSS will review your claim, which typically takes 10 to 30 working days, though it may take longer if additional verification is needed.
    • If approved, the benefit is credited to your registered bank account or e-wallet within five banking days from the date of settlement. You’ll be notified via email or SMS, and you can check the status in the Inquiry Module of your My.SSS account.
    • This step is like waiting for your neighbor to hand over the umbrella—once they’re sure you need it, you’ll get it quickly.

How is the SSS Sickness Benefit Calculated?

The SSS Sickness Benefit is calculated based on your average daily salary credit (ADSC). Here’s the step-by-step process:

  1. Identify the Semester of Sickness: Determine the two consecutive quarters ending in the quarter of your sickness. For example, if you’re sick in June 2025, the semester is January to June 2025.
  2. Exclude the Semester of Contingency: Look at the 12 months before the semester of sickness (e.g., December 2024 to January 2024 for a June 2025 sickness).
  3. Select the Six Highest Monthly Salary Credits (MSCs): Identify your six highest MSCs within those 12 months, capped at PHP 20,000.
  4. Calculate Total MSC: Sum the six highest MSCs.
  5. Calculate ADSC: Divide the total MSC by 180 to get your ADSC.
  6. Calculate Daily Sickness Benefit: Multiply your ADSC by 90% to get your daily benefit amount.

Example Calculation:

StepDescriptionCalculation
Total MSCSum of six highest MSCs (e.g., 6 x PHP 10,000)PHP 60,000
ADSCTotal MSC ÷ 180PHP 60,000 ÷ 180 = PHP 333.33
Daily BenefitADSC x 90%PHP 333.33 x 0.9 = PHP 300

So, if Kuya John’s six highest MSCs are PHP 10,000 each, his daily benefit would be around PHP 300, up to a maximum of 120 days per year. If the same illness persists beyond 240 days, it becomes a disability claim.

Three Steps to Calculate Your SSS Contributions

To stay eligible for the SSS Sickness Benefit, you need to pay your contributions regularly. Here’s how to calculate them:

  1. Find Your Monthly Salary Credit (MSC):
    • Check the SSS Contribution Table to find the MSC that matches your monthly income. For example, if Aling Nena earns PHP 10,000 a month, her MSC is PHP 10,000.
  2. Calculate Your Contribution:
    • Multiply your MSC by 15% (the 2025 contribution rate). For an MSC of PHP 10,000, the total contribution is PHP 1,500. Employees pay 5% (PHP 500), with employers covering 10% (PHP 1,000). Self-employed or voluntary members pay the full 15% (PHP 1,500).
  3. Pay On Time:
    • Use GCash, Bayad Centers, or online banking to pay monthly or quarterly. Timely payments ensure you remain eligible for benefits like the sickness benefit.

Contribution Example:

Member TypeMSCTotal Contribution (15%)Employee Share (5%)Employer Share (10%)
EmployeePHP 10,000PHP 1,500PHP 500PHP 1,000
Self-EmployedPHP 10,000PHP 1,500PHP 1,500N/A

Benefit Payment Disbursement

Once your claim is approved, the SSS Sickness Benefit is disbursed through:

  • Your Unified Multi-Purpose Identification (UMID) card enrolled as an ATM, or
  • Your preferred bank account or e-wallet registered in the DAEM.

For employed members, employers may advance the payment, which SSS reimburses. The payment is credited within five banking days from the date of settlement, and you’ll be notified via email or SMS. You can also check the status in your My.SSS account.

Why Contribute to SSS?

Contributing to SSS is like planting a mango tree today—you might not see the fruit right away, but it’ll be there when you need it. Regular contributions ensure you’re eligible for benefits like the sickness benefit, which can be a lifeline during tough times. Whether you’re Aling Nena stocking shelves or Kuya John driving passengers, every peso you contribute builds a stronger safety net for you and your family.